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Ask the Doctor

Vulval and vaginal conditions are embarrassing for many women. It can prevent women seeking help from their specialist. Here are some answers to common questions around vaginal discharge and vulvodynia-vaginal irritation that you may be too embarrassed to ask.

1. What can it mean if you have creamy, white discharge?
2. What can it mean if you have watery discharge?
3. What can it mean if you have green discharge?
4. What can it mean if you have really smelly discharge? Is there anything you can do to get rid of the smell?
5. If you have a sudden increase in discharge, that continues for weeks on end, what can this mean?
6. What can it mean if you have a burning sensation when you wee?
7. What can it mean if you have a burning sensation during or after sex?
8. What can it mean if your vaginal lips are swollen?

It is so important to emphasise that in the majority of cases, vaginal discharge is 'physiological' - meaning it is normal. The vagina and cervix are both full of tiny glands that produce mucus. The amount can vary depending on where you are in your monthly cycle, what contraception you are using and your age. Some women experience discharge on a daily basis, others only at certain points in their life. Most women dislike having any sort of vaginal discharge and are concerned with feelings of being dirty.
Thrush causes a thick white 'cottage cheese - like' discharge associated with itching around the vagina and vulva. Thrush is a yeast infection most commonly caused by the fungus Candida Albicans. A course of antibiotics can allow the candida to overgrow in the vagina, hence many women notice symptoms after being treated for an infection elsewhere. It is easily treated with over-the-counter treatment and a combination of a pessary into the vagina and cream to the vulva works best. If you suffer from recurrent infections or do not find the treatments to be effective, consult your doctor. Back to top

Clear watery discharge is a normal, healthy vaginal discharge. This fluid acts to keep the vagina clean and free from infection by flushing away harmful bacteria and dead cells. It also acts as a natural lubricant for the vagina during sex, preventing pain and friction. Discharge can increase with the female hormone oestrogen and so amounts of discharge can vary in a cyclical pattern during a monthly menstrual cycle. After the menopause, oestrogen levels are much lower and this leads to vaginal atrophy (thinning of skin within the vagina). This condition of atrophy can also produce a watery discharge.Back to top

A green vaginal discharge can be a sign of infection. There are several infections that can be passed on during sex that can cause a green discharge. Other signs of infections include irregular vaginal bleeding, pelvic pain or fever. It is always worth seeing a doctor about green discharge as swabs from the cervix and vagina can diagnose conditions such as chlamydia or gonorrhoea. These infections can be effectively treated with antibiotics. Condoms are an effective way of preventing sexually transmitted infections.Back to top

Bacterial vaginosis (BV) is a common cause of a smelly vaginal discharge. Women are acutely aware of a 'fishy' smell and often notice that sex precipitates symptoms. Your vagina is usually acidic to maintain the level of 'good' bacteria called lactobacilli. A shift in the pH balance of the vagina to a less acidic environment can allow an overgrowth of 'bad' anaerobic bugs that replace the lactobacilli, causing BV.
Women with an offensive discharge often find themselves constantly washing and douching the vagina to try to prevent the odour. This, in fact, further disrupts the bacterial balance in the vagina. Although tempting to use feminine wipes and soaps to the area, the best advice is to avoid all perfumed soap products and deodorants on the vulva. It is imperative to limit cleaning to a daily shower and use a soap substitute.
Semen is alkaline and so its' contact with the acidic vagina can alter the pH balance. Using condoms can limit episodes of BV after sex by preventing semen entering the vagina.
Having your period is another cause for pH disturbance and BV. Changing sanitary products regularly (every three hours during the daytime) can help.Back to top

You can notice significant increases in discharge at certain times in your life. Puberty, pregnancy, menopause and changes in contraception are all triggers for an increase in vaginal secretions. It is extremely unlikely that vaginal discharge is an indicator of a serious underlying problem but rarely it can be due an inflammatory condition or a cancer. If you are concerned about a new and persistent discharge, a simple examination by your doctor can exclude any diseases of the vagina or cervix.Back to top

This is a common symptom and most women will experience it at some point in their lifetime. Urinary tract infections (UTIs) lead to frequently needing to wee with associated pain that is often described as burning in nature. It is sometimes accompanied by more general symptoms such as fatigue, nausea and fever. A UTI can easily be diagnosed on a urine sample and is treated with antibiotics.
Non-infective cystitis is caused by inflammation of the bladder. The bladder becomes irritable and causes burning when you urinate. The bladder does not completely empty resulting in passing tiny amounts of urine frequently. Symptoms should improve with simple measures such as increasing the amount of water you drink and pain relief.
These problems are far more common in women than men owing to the close proximity of the vagina to the anus. Always wipe from front to back after passing urine to avoid bugs moving from your bottom towards the vaginal opening.Back to top

Vulvodynia is a condition where a woman experiences a burning pain around the opening of the vagina during sex or touching (including inserting a tampon). It is diagnosed when the other causes of burning pain have been excluded by your doctor (infections, menopausal lack of oestrogen, nerve disorders, inflammatory conditions or pre-cancer).
Vulvodynia is a complex pain disorder and the symptoms may be overlooked due to the absence of any abnormalities on examination of the vulva. If left undiagnosed and untreated, it can have a huge impact on an individual’s ability to have a normal sex life and have a detrimental effect on relationships. If you have vulvodynia, you should be referred to a specialist in vulval disease.Back to top

The lips around the opening of the vagina are called the labia minora. There is no 'normal' size or shape to these lips, every woman has an appearance that is individual to them.
Swelling of the labia minora rarely occurs in isolation and is usually accompanied by itching, soreness, skin splitting or redness. It can indicate an infective or inflammatory process on the vulva. When skin is inflamed and irritated, it is important to avoid potential irritants. Stick to cotton or silk underwear and avoid wearing pantiliners as much as possible. Do not be tempted to use perfumed or soapy products on the vulva and keep clothing loose (avoid jeans, leggings, tights and pyjamas). Treat any thrush infections with over the counter medications but if these simple measures are not improving your symptoms, consult your doctor.Back to top